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Swelling and water retention

Everything in the library studied for it, medical and holistic together. Within each kind, what was shown to help comes first, strongest evidence first. What was tested and not shown to help stays on the list.

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Medication4 Supplements4 Therapies5

Medication

Loop diureticsLimited

Swelling and fluid in heart failure

Limited evidence: label trials found torsemide cut weight and swelling more than placebo in heart failure, and higher furosemide doses removed more fluid in acute heart failure.

Compared with placebo [1]; a lower furosemide dose [2]

The numbers and sources

Effect: In controlled trials in NYHA class II to IV heart failure, torsemide 10 to 20 mg a day produced significantly greater reductions in weight and swelling than placebo [1]. In acute heart failure, furosemide at 2.5 times the previous oral dose gave greater fluid removal than the previous dose itself, with a trend toward better symptom scores (P=0.06) and some transient worsening of kidney function [2].
Population: Patients with heart failure in label trials [1]; 308 patients hospitalized with acute decompensated heart failure [2].
Sources: [1], [2]
Caveats: The label gives no sizes for the placebo comparison [1]. The placebo-controlled trials behind the oldest uses are decades old, and no recent pooled placebo-controlled analysis was found.

BenzopyronesLimited

Lymphedema of the arms and legs

Small trials found opposite results: coumarin reduced excess limb fluid in one crossover, while a trial in 140 women after breast cancer found no change in arm volume.

The numbers and sources

Effect: A Cochrane review included 15 trials, 8 of them of coumarin. Meta-analysis was not done because of poor trial quality, and the authors could not draw conclusions about limb volume, pain or discomfort [1]. In a crossover trial of 400 mg a day against placebo for six months each, coumarin reduced excess arm fluid from 46% to 26% above normal and excess leg fluid from 25% to 17% (p < 0.001), and 93% of patients preferred it [2]. In 140 women with arm lymphedema after breast cancer, 200 mg twice a day against placebo for six months each did not change arm volume. The affected arm grew by 21 mL during placebo and 58 mL during coumarin (P 0.80), and 15% on coumarin against 10% on placebo said the medication helped a moderate or large amount (P 0.19) [3]. A 2022 review of lymphedema drug trials noted that earlier meta-analyses had cast doubt on the positive benzopyrone results [4].
Population: 31 people with arm lymphedema after mastectomy and 21 with leg lymphedema in Australia [2]. 140 women with arm lymphedema after breast cancer treatment in the US [3]. Trials in the Cochrane review included five in India or China that added anti-filarial drugs [1].
Sources: [1], [2], [3], [4]
Caveats: The two most detailed trials reached opposite results [2][3]. Three trials in the Cochrane review involved the same researcher [1]. The Australian trial authors note this coumarin is not an anticoagulant [2].

Loop diureticsModerate

Continuous drip against injections in acute heart failure

Not shown to differ in deaths, readmissions or kidney injury between a continuous intravenous drip and repeated injections of loop diuretics in acute heart failure.

Compared with bolus injection [7][2]

The numbers and sources

Effect: All-cause mortality (RR 1.53, 95% CI 0.81 to 2.90), readmission (RR 0.85, 95% CI 0.63 to 1.16) and acute kidney injury (RR 1.02, 95% CI 0.70 to 1.49) did not differ. Weight loss was 0.86 kg greater with a drip, but not in trials at lower risk of bias (MD 0.70 kg, 95% CI -0.06 to 1.46) [7]. In a double-blind trial, symptom scores and creatinine change at 72 hours did not differ between a furosemide drip and injections every 12 hours [2].
Population: 681 adults in 7 trials [7]; 308 patients [2].
Sources: [7], [2]
Caveats: Low to very low certainty evidence [7].

Loop diureticsLimited

Stopping low-dose furosemide in stable heart failure

One trial found stopping low-dose furosemide in stable heart failure with no fluid retention did not worsen breathlessness over 90 days, and 75% stayed off it.

Compared with continuing furosemide, against placebo [8]

The numbers and sources

Effect: Breathlessness scores did not differ between withdrawal and continued furosemide (median AUC 1,875 against 1,541, P=0.94). 75.3% of the withdrawal group and 83.7% of the continuing group needed no extra furosemide (OR 1.69, 95% CI 0.82 to 3.49). Heart failure events were infrequent and similar [8].
Population: 188 stable outpatients with heart failure, ejection fraction 45% or less, on furosemide 40 or 80 mg a day, 25% women [8].
Sources: [8]
Caveats: Small, 90 days, and limited to people with no signs of fluid retention.

Supplements

BromelainLimited

Bruising and swelling after skin procedures

Limited evidence: 5 of 7 small trials reported less bruising or swelling after skin procedures, and the reviewers judged the data insufficient.

The numbers and sources

Effect: A systematic review found 7 trials of oral bromelain for bruising or swelling after cosmetic, laser and surgical skin procedures. Five of the 7 reported improvement, and the authors judged the data insufficient [5].
Population: People having skin, cosmetic or surgical procedures [5].
Sources: [5]
Caveats: The abstract does not give effect sizes or pooled results [5].

Grape seed extractLimitedStudied in women

Leg swelling while sitting

One small trial found less leg swelling during 6 hours of sitting in healthy Japanese women.

The numbers and sources

Effect: In a double-blind, placebo-controlled crossover study, a single dose and a 14-day course both reduced the increase in leg volume, body extracellular fluid and leg water during 6 hours of sitting [8].
Population: Healthy Japanese women. The abstract does not give the number [8].
Sources: [8]
Caveats: One small study in healthy women. The abstract gives no effect sizes [8].

SeleniumLimited

Lymphedema

Small trials found less lymphedema and fewer skin infections in people after cancer treatment, two of them giving selenium by vein.

The numbers and sources

Effect: A Cochrane review found one RCT of selenium for secondary lymphedema, with 60 participants at the start. It reported fewer recurrent erysipelas infections on selenium than on placebo [9]. In 26 women with stage II to III lymphedema after breast cancer, five intravenous doses of 500 µg sodium selenite within 2 weeks shifted 83.3% from stage III to II at follow-up, against 10.0% on saline (p 0.002), and lowered the extracellular water ratio [10]. In 20 patients after oral cancer surgery, 1,000 µg sodium selenite a day by mouth or vein for 3 weeks reduced postoperative lymphedema [11]. A 2022 systematic review of lymphedema drug trials found one small RCT suggesting selenium might help [12].
Population: Cancer patients with secondary lymphedema [9]. 26 women with breast cancer-related lymphedema [10]. 20 patients after oral tumor surgery [11].
Sources: [9], [10], [11], [12]
Caveats: The Cochrane authors note drawbacks in study quality and reporting, and that the result cannot be generalized [9]. All trials are small, and two gave sodium selenite intravenously [10][11].

BromelainLimited

Swelling after wisdom tooth surgery

Limited evidence: reviews of overlapping trials disagree, with two finding less swelling after wisdom tooth surgery and two finding no effect.

The numbers and sources

Effect: One meta-analysis found less facial swelling early (SMD -0.24, 95% CI -0.46 to -0.02) and late (SMD -0.54, 95% CI -0.84 to -0.24) after surgery [1]. Another found less edema (MD -0.34, 95% CI -0.68 to -0.01) [2]. Two others found no significant effect on swelling [3][4].
Population: Adults having lower third molar surgery [1][2][3][4].
Sources: [1], [2], [3], [4]
Caveats: Reviews of overlapping trials reached opposite results.

Therapies

Lymphatic drainage massageLimited

Swelling after cosmetic and dental surgery

Limited evidence: a review of small studies after liposuction and tummy tucks, and one trial after wisdom tooth removal, found less swelling with drainage.

Compared with standard postoperative care [8][9]

The numbers and sources

Effect: Across 7 studies after cosmetic procedures such as liposuction and abdominoplasty, drainage alone or with other therapies reduced swelling, with variable effects on pain and fibrosis. Effects were larger when started on days 2 to 5 and given over 6 to 12 sessions [8]. After removal of both lower wisdom teeth, the side given drainage had less swelling, pain and jaw stiffness on days 3 and 7 than the side given routine care (p < 0.05) [9].
Population: 7 studies, mostly randomized or prospective, of adults after cosmetic surgery [8]. 46 patients aged 18 to 26 in a split-mouth trial [9].
Sources: [8], [9]
Caveats: The cosmetic review could not pool results because the studies differed too much [8]. The dental trial was registered after it was done [9].

Lymphatic drainage massageModerate

Lymphedema after breast cancer, compared with no drainage

Mixed results: in one review, drainage added 7% more swelling reduction to compression bandaging, while two later meta-analyses found no significant reduction in arm volume.

Compared with compression bandaging alone [1]; standard physiotherapy alone [1]; control groups without drainage [3][4]

The numbers and sources

Effect: Added to compression bandaging, drainage gave an additional 7.11% reduction in swelling (95% CI 1.75% to 12.47%, 2 trials, 83 participants), and added to standard physiotherapy it did not differ. Pain and heaviness eased in both groups with no difference between them [1]. A later review found no significant effect on volume or quality of life, and lower pain (SMD -0.72, 95% CI -1.34 to -0.09) [3]. Another found no significant reduction in lymphedema (SMD -0.09, 95% CI -0.85 to 0.67, 8 trials, 338 patients) [4].
Population: 6 trials of 24 to 45 women each [1]. 1,564 patients in 11 trials [3]. 338 patients in 8 trials [4].
Sources: [1], [3], [4]
Caveats: Trials were small, and in four of the Cochrane trials the person measuring swelling knew the treatment [1]. None of these comparisons used placebo drainage.

Lymphatic drainage massageModerate

Preventing lymphedema after breast cancer surgery

Mixed results: the largest trial found arm lymphedema in 24% with drainage and 19% without at one year, while pooled analyses disagreed about prevention.

Compared with the same guidelines and exercise therapy without drainage [5]; control groups without drainage [3][4]

The numbers and sources

Effect: After axillary lymph node removal, 12-month incidence of arm lymphedema was 24% with drainage and 19% without (OR 1.3, 95% CI 0.6 to 2.9), and time to lymphedema did not differ [5]. Pooling 4 trials with 1,364 patients, drainage did not significantly lower the risk (RR 0.61, 95% CI 0.29 to 1.26) [4]. Another review found a lower incidence (RR 0.58, 95% CI 0.37 to 0.93) [3].
Population: 160 patients after breast cancer surgery with axillary node dissection in Belgium [5]. 1,364 patients in 4 trials [4]. Patients in 11 trials [3].
Sources: [5], [4], [3]
Caveats: The two pooled analyses overlap in their trials and disagree. The largest single trial was designed to detect a large effect [5].

Lymphatic drainage massageStrong

Swelling after knee replacement

Not shown to reduce leg swelling, pain or stiffness after knee replacement, in two meta-analyses of randomized trials.

Compared with no drainage [6]; no drainage or other physiotherapy [7]

The numbers and sources

Effect: Across 4 trials, knee flexion, pain and the circumference of the thigh, knee, calf and ankle did not differ with drainage [6]. Across 7 trials, knee flexion (SMD 0.03, 95% CI -0.22 to 0.28), knee extension, leg circumference (SMD -0.09, 95% CI -0.27 to 0.09) and pain (SMD -0.33, 95% CI -0.71 to 0.04) did not differ [7].
Population: 197 knee replacements, mean age 69.6, followed about 7 weeks [6]. 285 patients in 7 trials [7].
Sources: [6], [7]
Caveats: The two reviews share trials. Trials were small.

Lymphatic drainage massageLimited

Lymphedema after breast cancer, compared with placebo drainage

One trial of 194 people found adding manual lymphatic drainage to decongestive therapy reduced arm swelling no more than placebo drainage.

Compared with placebo manual lymphatic drainage, all groups also receiving compression, skin care, exercise and education [2]

The numbers and sources

Effect: After 3 weeks of intensive treatment, excess arm volume fell by 5.3 percentage points with fluoroscopy-guided drainage, 5.2 with traditional drainage and 5.4 with placebo drainage. Fluoroscopy-guided drainage differed from placebo by -0.2 percentage points (95% CI -2.1 to 1.8). Fluid built up at the shoulder and trunk in all groups, and secondary outcomes showed no clinically important differences [2].
Population: 194 people with chronic lymphedema on one side after breast cancer, at 5 hospitals in Belgium, followed through 6 months of maintenance treatment and 6 months of follow-up [2].
Sources: [2]
Caveats: One trial in chronic lymphedema. Participants and assessors were blinded [2].